All information you provide will be kept private.

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Client Intake and Liability Waiver


Review Privacy Policy

Intent

My mission is to help you to become as strong and graceful, as vital and peaceful in your body as you want to be. I am your guide and coach, but not the boss. Our working relationship is a dialogue and collaboration. Do not hesitate to talk to me about any questions and concerns you have regarding your training. Let me know if your fitness goals or movement interests change, or if you would like me to take a different approach to your programming. I am not committed to any given exercise, technique or methodology. I promise to bring enthusiasm, presence, a willingness to listen, intellectual curiosity and a playful spirit to our sessions. I hope you will do the same and be actively engaged in our process. I look forward to creating meaningful, effective sessions with you.


Please read and initial, indicating that you agree to the following terms:

All training fees include Washington State Sales Tax. Sessions are 55 minutes each. Please allow 24 hours notice of cancellation. Missed appointments, cancellations and rescheduling done within less than 24 hours will be charged in full.


Participant Release and Acknowledgement of Agreement

I wish to participate in the exercise and training program offered by Amanda Ford. I understand there are inherent risks in participating in a program of strenuous exercise; consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program. If I choose not to see a physician prior to beginning a fitness program, I do so strictly at my own risk. I further agree that Amanda Ford shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, outdoors or in any fitness facility), and I expressly release and discharge Amanda Ford from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program, excepting only and injury caused by an intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators, and assigns. I have read and understand this term:


I certify that the answers to the questions outlined on the PAR-Q Health Questionnaire Form are true and complete to the best of my knowledge. I acknowledge that medical clearance is requested if I have answered “Yes” to any of the questions on the PAR-Q form. I understand and agree that it is my responsibility to inform Amanda Ford of any condition or changes in my health, now and on going, which might affect my ability to exercise safely and with minimal risk of injury. I have read and understand this term:


I understand that Amanda Ford will make every reasonable effort to preserve the privacy of the information contained in this Client Intake Form. I further agree that Amanda Ford shall not be liable or responsible to me for any inadvertent disclosure of the information contained in the Client Intake Form and I expressly release and discharge Amanda Ford and Northwest Fitness Project from all claims, actions, judgment and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any damage which may occur in connection with disclosure of private information contained in the Client Intake Form. This release shall be binding upon my heirs, executors, administrators and assigns. I have read and understand this term:


I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participations at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform Amanda Ford. I have read and understand this term: 


Date: May 13, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity should be fun, safe, and healthy. Prior to starting a new exercise program, we recommend that you consult with your physician for any potential concerns. Please read the following questions carefully and answer each one by checking YES or NO.

Has your physician ever said you have a heart condition and/or have they limited your physical activity due to this condition?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced any chest pain when you were NOT doing physical activity?*
No
Yes
Do you lose your balance due to dizziness or ever lose consciousness?*
No
Yes
Are you currently taking any prescription drugs for a heart condition or high blood pressure (e.g. water pills)?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in physical activity?*
No
Yes
Are you over 69 years of age?*
No
Yes
Do you know of any other reason why you should not engage in a new physical activity?*
No
Yes

If you answered YES to one or more of the above questions:

Talk with your physician before you beginning your training program. 

Your physician might limit your activities to ones they deem safe. Please bring written instructions from your physician outlining your exercise guidelines. 

You might be able to do any activity you want as long as you start slowly and build up gradually. Remember that NO exercise should ever cause pain. Stay within your fitness abilities, ask the trainer for modifications, and consult with your physician if in question.

I choose not to consult my physician and assume full responsibility for any risks associated with my fitness program with Amanda Ford in person or virtual.

If you answered NO to all of the above questions:

You may begin your training program.

HEALTH HISTORY

Do you currently have or have you had any of the following physical conditions? Please describe as much about your condition as you believe to be relevant.

Injury / Pain / Surgery in Toes, Feet or Ankles?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Knees?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Hips or Pelvis?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Spine?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Shoulders?*
No
Yes

If yes, please describe:

Injury / Pain / Surgery in Elbow, Wrist, Hand or Fingers?*
No
Yes

If yes, please describe:

Are you pregnant?*
No
Yes

If yes, how many weeks along?

If you have given birth, did you have a vaginal birth, c-section or both?*
Vaginal birth
C-section
Both
N/A
Abdominal Surgery other than c-section?*
No
Yes
Pelvic Organ Prolapse?*
No
Yes
Stress or Urge Incontinence?*
No
Yes
Auto-Immune Disease?*
No
Yes
Cardiovascular Disease?*
No
Yes
High / Low Blood Pressure?*
No
Yes
Diabetes / Hypoglycemia / Hyperglycemia?*
No
Yes
Asthma?*
No
Yes
Stroke?*
No
Yes
Cancer?*
No
Yes
Osteoporosis / Osteopenia?*
No
Yes
Anxiety / PTSD*
No
Yes

Is there anything else you would like me to know about your physical or mental health before we begin our training?

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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